Accessibility to and Utilization of Primary Health Care in the Ga, Dangme East and Dangme West Districts of the Greater Accra Region

Abstract

The study examined the accessibility and other socio-economic forces that influence the utilization of primary health care services in the rural parts of the Greater Accra Region of Ghana. Three administrative districts, Ga, Dangme West and Dangme East, were selected for study. Both qualitative and quantitative data were used. Questionnaire and interview schedules reinforced by focus group discussions and observations, were the main research instruments. Descriptive and multivariate techniques are the analytical tools. The main factors that influenced utilization as established by the empirical research, have been income, distance, transport and service costs, waiting and travel times, educational status in the analysis. The researcher establishes that, the main factors that influence utilization of primary health care services in the rural parts of Greater Accra Region are income and distance. The other factors are service costs, transport cost and waiting time. Income shows a positive relationship with utilization, whilst service cost exhibits a negative relationship to validate the hypotheses. Income makes a stronger impact than distance, service cost and waiting time. The impact of education, though statistically significant, is weak. There were differences by place of residence, and also by health status (patient and nonpatient). With regard to income, the impact at the Ga District is stronger than that of the Dangme West and Dangme East Districts, whilst non-patients are more affected than patients. With regard to distance and utilization, the Dangme East and Dangme West Districts show a stronger negative impact than the Ga District, whilst the impact of patients is stronger than non-patients. Waiting time and service costs have a greater impact in the Ga District than in the Dangme West and Dangme East Districts. For health status, patients are more affected by distance than non-patients. Several recommendations have been made to enhance utilization and the quality of health and health care. These include among others the strengthening and upgrading of primary health care facilities in the rural districts, improvement of the quantity and quality of medical and paramedical staff and the introduction of a National Health Insurance Scheme.